Provider Demographics
NPI:1780680835
Name:HALL, BERNADINE HENLY (ARNP)
Entity Type:Individual
Prefix:MISS
First Name:BERNADINE
Middle Name:HENLY
Last Name:HALL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MISS
Other - First Name:BERNADINE
Other - Middle Name:
Other - Last Name:HENLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2828 CROASDAILE DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-2505
Mailing Address - Country:US
Mailing Address - Phone:877-751-1157
Mailing Address - Fax:919-425-1596
Practice Address - Street 1:1100 NW 95TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33150-2038
Practice Address - Country:US
Practice Address - Phone:305-835-6191
Practice Address - Fax:305-694-3649
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1701372363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
S83263Medicare UPIN